Tuesday, January 23, 2018

Life as a Missionary PT Part 1: Patient Demographics and Sourcing

Several people have asked me what it's like to work as a missionary physical therapist. They want to know things like, "What kind of women do you treat?" "How do you bill for therapy?" and "What's the typical doctor visit like?" Well, my friends, here you go!

(Remember, I'm just sharing my personal experience with this particular hospital in this particular country. Other missionaries at this same center will have different viewpoints, as will missionary PTs serving in other places.)

Today, I want to tell you a bit more about the type of women we see and how our patients find us. One of our staff members has been keeping records for the last 5 years regarding patient age, religion, marital status, education level, parity (number of pregnancies), and live births. I won't share the exact stats here, but our patients usually fall into one of these categories:

  • Ages 1-14, never married or sexually active, some primary level education, leaking urine/stool since birth (usually caused by a birth defect), accompanied by her mother or auntie.
  • Ages 15-50, usually married young but divorced now as a result of the urinary leakage, some primary level education, her problem may have developed after the first childbirth (as is often said to be the cause of VVF) or after several successful deliveries, often had at least one stillbirth, may live in her father's house, often comes on her own or if she doesn't speak Hausa the mother/auntie/brother may accompany her
  • Ages 50-65, either started leaking after a pregnancy many years ago and is just now finding out about our center, or started leaking a few months ago (often related to a cervical cancer or advanced AIDS), accompanied by a daughter/son
Interestingly, about 51% of our patients are M**lim, even though we are a Christian hospital located in a predominantly Christian part of the country. 

I'd guess that 95% of our patients are verbally fluent in some non-English language (usually Hausa, with a few that speak Fulfulde or Tiv). A few of those patients can hear some English like simple commands or greetings, but cannot answer in English or understand medical questions. We don't gather statistics on literacy, but I would imagine that less than 20% can read or write Hausa, and about 1% can read or write in English.

How do these women find us? In recent years, Nigerian media has started publishing more stories about VVF--often focused blaming the family members and on the woman's shame that VVF causes, but there was also a well-produced Nollywood film released in 2016 about VVF. Unlike in other African countries where AIDS awareness/proper condom use/malaria information is posted on huge billboards, I have not seen any such postings about VVF in Nigeria. The Western world is starting to pay more attention to the plight of these women as we're starting to care more about social justice and women's equality... but that actually does little here in Nigeria.

There are several centers around the country where a woman can have a fistula surgery; some of the surgeons are more skilled than others, and some centers (like ours) offer more drastic procedures while other centers only perform simple repairs. Many places require payment for the fistula surgery, but some hospitals and temporary "fistula camps" set up throughout the country offer free services through outside funding like the United Nations Fistula Project or Worldwide Fistula Fund.

Our women find us through word of mouth from other patients (as is the case with many of our M**lim patients from the North), are referred here for a more complex surgery than what can be done by our surgeon assisting in a fistula camp, or are referred from a surrounding hospital (as is often the case when the fistula is fresh or was caused by another vaginal/abdominal surgery). Sometimes, we never can quite figure out how they found out about us! Googling or searching a online physician directory isn't really a thing here!

So each Tuesday when we do clinic, we never quite know how many women will come, which patients will return for their follow ups, how many new patients we'll have, or what their stories will be. 

What we do know is that we are ready to receive each woman with kind hearts, listening ears, and skilled hands. And as she has finally arrived to our center--sometimes after multiple failed surgeries at other places--she has arrived to a place of hope. We are only human, but we serve a great God who heals.

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